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Paediatric emergency department design: Does it affect staff, patient and community satisfaction?

OBJECTIVES: To assess the change in perception of the standard of paediatric care following the opening of a dedicated paediatric emergency area in an established tertiary hospital emergency department on patients and families, hospital staff and the general practitioners of the local community. METHODS: A questionnaire was circulated to the relevant parties prior to and 6 months after the opening of the paediatric department. The surveys were circulated to the families/custodians of the paediatric attendees, general practitioners who refer paediatric patients and the medical and nursing staff both within the emergency department and the inpatient paediatric ward. The questions related to the physical environment, perceived level of care and the overall satisfaction with treatment. RESULTS: The most striking change was in the patient family group who showed an increase in their level of satisfaction with the physical environment and their overall care. The general practitioner group showed only a slight improvement, while the inpatient staff showed no notable changes. The emergency department staff developed a higher level of confidence and satisfaction when dealing with this population group. CONCLUSION: The change in the physical environment in which we treat our paediatric emergencies seemed to enhance the level of satisfaction of our attendees. Staff appear to be more confident when dealing with these patients in a dedicated paediatric area. The effect has not yet flowed on to the inpatient staff and general practitioners, perhaps reflecting a small exposure of these individuals to the survey subject matter.

Attitude of Health Personnel↗

Non-A, non-B hepatitis: a prospective study of a hemodialysis outbreak with evaluation of a serologic marker in patients and staff.

An outbreak of non-A, non-B hepatitis (NANBH) in a hemodialysis unit was prospectively studied and the clinical, biochemical, and serologic events were correlated with an experimental immunodiffusion assay for serum antigen and antibody. One hundred sixteen subjects (76 dialysis patients and 40 staff members) were studied over an 8-month period. Hepatitis was defined as two consecutive SGPT levels greater than two times the upper limit of normal occurring in two separate samples drawn greater than 7 days apart in the absence of other likely causes of liver disease. Weekly serum specimens were obtained and tested for SGPT, SGOT, alkaline phosphatase, bilirubin HBsAg, anti-HBc, anti-HBs, total anti-HAV, and anti-HAV IgM by commercial reagents, and for antigen and antibody by agar gel diffusion using reference reagents previously obtained from well-documented posttransfusion NANBH patients. Clinical evaluations were performed three times per week. Thirty patients and none of the staff developed NANBH. The NANBH patients were asymptomatic, except for two patients with jaundice. Fifteen of the 30 patients were positive for antigen which was detectable in at least one serum collected during the acute phase. Six patients and 10 staff without clinical NANBH or abnormal serology had antigen. Antigenemia was also observed in three patients with acute hepatitis B, with chronic hepatitis B in one patient and with alcoholic hepatitis in one patient. Thus, an antigen was detected in a high proportion of patients during the acute phase of NANBH, and it was also found in exposed patients who had other liver diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Two-year follow-up after intracoronary gamma radiation therapy.

BACKGROUND: Neointimal hyperplasia and unfavorable remodeling have been demonstrated to be the major limitation to endovascular revascularization procedures. Intracoronary gamma radiation therapy has been shown to reduce the restenosis index. However, the late effects of these novel procedures are unknown. MATERIALS AND METHODS: To evaluate the long-term effects on clinical and angiographic outcome of endovascular gamma radiation therapy following percutaneous transluminal coronary angioplasty (PTCA), serial angiography over a 2-year period was performed in 21 patients (22 lesions) who were treated with 192Ir in doses of 20-25 Gy after PTCA. Angiograms were analyzed using quantitative methods (QCA). RESULTS: The mean late loss between PTCA and 6 months was 0.20 +/- 0.59 and 0.13 +/- 0.84 between 6 months and 2 years. At 6 months, angiographic binary restenosis was present in six arteries (27.2%). At 2 years, binary restenosis was observed in six arteries (27.2%), including one patient who had developed restenosis and excluding one patient with spontaneous regression. Two early pseudoaneurysms and two late aneurysms were observed at 6 months, with little increase at 2 years. No other angiographic complication was observed. None of the patients or medical staff developed complications or illnesses that could be related to the effects of the radiation procedure. CONCLUSIONS: Gamma radiation therapy decreases late luminal loss, is safe and free of unexpected complications at 6 months follow-up, with no significant changes or late complications at 2-years' follow-up.

Adult↗

Daring decisions. Making an impact on physician recruiting.

In 1987 the trustees of 59 bed Habersham County Medical Center decided to build a new hospital complete with new technology in order to survive the lure of larger hospitals in less rural nearby areas. When Dick Dwozan became the CEO of the centre three years ago, he inherited this still unfulfilled dream and knew that it would take organization, determination, and some hard decisions for the aspiration to come true. The farsighted Dwozan realized that HCMC's success in the years ahead lay beyond the construction project. Four key areas required this immediate attention: physician recruitment, internal staff development, marketing and long-range planning, and improvement of its public image.

Georgia↗

The relation of work stress, hardiness, and burnout among full-time hospital staff nurses.

In this descriptive study, the author examined the relation of work stress, hardiness, and burnout among 113 full-time hospital staff nurses. It was hypothesized that among hospital staff nurses: 1) the greater personality hardiness, the less job stress; and 2) the greater personality hardiness, the less burnout. Instruments used were Personal Views Survey, Nursing Stress Scale, and Tedium Burnout Scale. Promoting hardiness through nursing staff development programs may help manage stress and reduce burnout in the healthcare setting.

Adaptation, Psychological↗

A surgical services learning needs assessment.

Staff development educators are challenged to meet the learning needs of a variety of subspecialties within surgical services departments. A formal learning needs assessment survey, based on the individual self-fulfillment model, provides a means to identify the educational needs of staff members. Using questionnaires constructed for various types of staff members within a surgical services department, the author assessed staff members' clinical, interpersonal, and sociopolitical learning needs. The response rate was 56%, and the identified needs were legal issues, research, equipment (eg, ultrasonic aspirators, pressure monitors), and procedures (eg, cerebral aneurysm repairs, arteriovenous malformation corrections). Limitations included self-identification of needs and a low response rate from one subspecialty; however, the author concludes that the survey format provides an effective means of identifying staff members' learning needs.

Attitude of Health Personnel↗

Therapeutic agents of assertive community treatment.

The goal of this study was to learn how assertive community treatment (ACT) contributes to the improvement of those with serious mental illness in order to contribute to the growing clinical literature regarding the therapeutic agents of ACT teams. Methods included reviewing the case records of three ACT clients who have improved significantly, as well as interviewing the clients themselves and their clinicians. The results indicated that there was significant agreement among the case records, the clients, and their clinicians in identifying the most useful aspects of assertive community treatment. Primary among these factors were the persistence demonstrated by ACT clinicians in engaging their clients, the trust that clients developed in their clinicians, and as a result, the process by which their clinicians became "guides" to the world of psychiatric and social services that further facilitated their clients' community adjustment. In closing, we consider implications from these findings both for staff development for ACT team members, and for suggestions toward the development of a model of recovery from serious mental illness.

Adult↗

Special Forces Medical Sergeants (18 Delta) recertification.

Special Forces Medical Sergeants (18 Delta) in the U.S. Army play a key role in delivering medical care in both combat and civil affairs arenas. Given the breadth of skills required and potential decrement of skills with time, recertification is desirable and mandated. However, there are no formal courses for recertification of 75% of the tasks. A course to fill this need is being developed. A general outline of the course is set forth. To date, the course has recertified 18 Deltas in several areas, received favorable evaluations from the students, and been embraced by the Special Forces battalion leadership. Additional benefits include the instructional staff developing a deployment combat perspective for their area of instruction and better integration between active Army and reserves. Thus far, the course has been very successful.

Allied Health Personnel↗

The organization of successful participative management in a health sciences library.

The University of Washington Health Sciences Library, Seattle, and its participative management process are described in detail. The evolution of the management system is reviewed by interrelating the various phases of the library's growth, its service complexities, and its communication needs. Staff development results of this participative management mode are discussed. Reference is made to the use of group dynamics concepts. The current organizational design, which integrates the participative subunit with the simple line management structure, is considered effective by both the library staff and its director.

Communication↗

Documenting patient education: a literature review.

Lack of time is cited as the most common reason why staff nurses neglect to document patient education. Consumer rights, standards of practice, and other laws regulating nursing practice require nurses to teach patients. Administration and staff development can enhance nurses' efforts to document more effectively. Forms and flowsheets detailing content and learner outcomes and tracking patients' progress can affect the quality of documentation. Nurses are encouraged to continue developing new forms and flowsheets and to share their products with others.

Forms and Records Control↗

The use of medication modules for medication administration problems.

Assisting nurses to accurately administer medications is a challenge that staff development educators currently face. Using a medication module format meets individual needs and can be adapted easily to various settings. This approach permits nurses to develop strategies in constructively dealing with medication errors in a non-threatening environment.

Humans↗

Helping hospital educators and clinical nurse specialists learn to use and develop computer-assisted instruction.

The impact of computers on healthcare delivery and management is both significant and increasing. Coupled with its potential educational benefits, computer-assisted instruction (CAI) has much to offer healthcare professionals. However, the individuals directly responsible for training nurses and other personnel typically have little knowledge about how computers can be used for training purposes. A series of workshops was designed for hospital educators and clinical nurse specialists to help them become computer literate and to provide them with the skills to evaluate, develop, and appropriately implement instructional software was emphasized during a series of formal seminars, guided individual instruction, and guided independent practice laboratory sessions. This approach resulted in a significant increase in participants' knowledge about computers while maintaining their positive attitudes toward the instructional uses of computers. A well-designed staff development program can provide these crucial individuals with the skills and knowledge required to use microcomputers and CAI as effective teaching and learning tools.

Computer User Training↗

Follow-up comparisons of intervention and comparison schools in a state tobacco prevention and control initiative.

This study provides information about prevention and control practices in intervention and comparison secondary schools 2 years after the start-up of the Texas Tobacco Prevention Initiative. The intervention, which was funded through the Texas Department of State Health Services, consisted of guidance, training, technical assistance, and reimbursement of approximately 2000 dollars per year for program expenses. Self-administered written surveys for Principals and Health Coordinators, based on the School Health Education Profile Tobacco Module, were designed for periodic assessment of the status of school programs. Surveys were sent in 2002 to intervention (n = 74) and comparison (n = 60) schools. Response to the Principal Survey was received from 109 (81%) schools, and response to the Health Coordinator Survey was received from 84 (63%) schools. Survey analysis showed that intervention schools more frequently (p <or= .05) reported: (1) being extremely or moderately active in student cessation support, teacher training, policy development, family involvement, and assessment of the prevention program; (2) using recommended curricula, offering more tobacco-related lessons, involving more teachers, and using more recommended teaching methods such as role-playing, simulations or practice, and peer educators; and (3) having more interest in staff development and more funding to purchase release time. Similarities across schools are provided, as well as recommendations for future planning.

Data Collection↗

Perinatal staff nurse medical device use and education.

BACKGROUND: How and what RNs working in the perinatal area initially learned about the medical devices they use and the sequelae of device use both for patients and staff were explored. METHOD: Eighty-five perinatal staff nurses working at a 500-bed tertiary care hospital in a medium-size midwestern American city were surveyed using a mailed questionnaire comprised of 26 open-ended and closed-ended questions pertaining to device education, consequences of device use, demographic characteristics, and employment situation. RESULTS: Most participants (n = 48, 62.3%) initially learned about the most frequently used device by reading the user/instruction manual. At least 90% (n = 77) of participants indicated they initially had learned how to operate the device, its purpose, function, and patient factors indicating use. Inadequate device knowledge was related to nurse stress, and being unsure how to use the device and fear of harming the patient were the two reasons most frequently identified as causing the stress. Six percent (n = 5) of staff nurses had used a device that caused patient harm. CONCLUSION: What RNs initially learn about medical devices may be related to how they learn, and the continuing increase in nurse use of medical devices has implications for all aspects of professional nursing: curriculum, teaching clinical nursing, continuing education and staff development, and research.

Adult↗

Bridging the theory-practice gap.

In New Zealand, there is a festering debate over a "theory-practice gap" in nursing. Joint appointments may be a potential solution to this issue. Joint appointments refer to a variety of arrangements whereby concurrent employment occurs within an educational institution and a clinical setting. Advantages for the appointees include job satisfaction and professional growth. Clinical credibility for nurse educators enables improved facilitation of student learning. In clinical areas, benefits in patient care are associated with the marrying of academic rigour with clinical practice. Some appointees assist with staff development, act as consultants on nursing issues and undertake research. Disadvantages in the concept focus on role conflict, i.e. incongruity between the roles and role ambiguity, i.e. lack of clarity concerning expectations. Success depends upon the personal attributes of appointees; realistic expectations; flexibility to allow the concept to evolve; and support from colleagues and management. This research describes a case study of a joint appointment between a nurse lecturer and a staff nurse in an acute forensic psychiatry unit. Advantages, disadvantages and reasons for success are discussed in relation to the literature findings. (See p15-15) The discussion focuses on the need to develop research methodology to further clarify potential benefits and advantages.

Clinical Competence↗

Information and research needs of acute-care clinical nurses.

The majority of nurses surveyed used the library on a regular but limited basis to obtain information needed in caring for or making decisions about their patients. A minority indicated that the libraries in their own institutions totally met their information needs. In fact, only 4% depended on the library to stay abreast of new information and developments in the field. Many of the nurses had their own journal subscriptions, which could account in part for the limited use of libraries and the popularity of the professional journal as the key information source. This finding correlates with the research of Binger and Huntsman, who found that 95% of staff development educators relied on professional journal literature to keep up with current information in the field, and only 45% regularly monitored indexing-and-abstracting services. The present study also revealed that nurses seek information from colleagues more than from any other source, supporting the findings of Corcoran-Perry and Graves. Further research is necessary to clarify why nurses use libraries on a limited basis. It appears, as Bunyan and Lutz contend, that a more aggressive approach to marketing the library to nurses is needed. Further research should include an assessment of how the library can meet the information needs of nurses for both research and patient care. Options to be considered include offering library orientation sessions for new staff nurses, providing current-awareness services by circulating photocopied table-of-contents pages, sending out reviews of new monographs, inviting nurses to submit search requests on a topic, scheduling seminars and workshops that teach CD-ROM and online search strategies, and providing information about electronic databases covering topics related to nursing. Information on databases may be particularly important in light of the present study's finding that databases available in CD-ROM format are consulted very little. Nursing education programs should be expanded to include curricula bibliographic sessions where the librarian, in cooperation with the teaching faculty, visits the classroom to explain all pertinent information sources or invites the class to the library for hands-on demonstration and practice. Nurses who gain working knowledge of the tools that open the doors to retrieval of research findings and who have information about new innovations in medicine and medical technology have superior chances for success in their chosen profession.

Adult↗

Hepatitis B vaccine: clinical trials in high-risk settings in France. (September 1975-September 1982).

An alum bivalent hepatitis B vaccine containing 5 micrograms/dose of formalin-inactivated and purified HBsAg has been prepared from plasma of HBeAg negative donors. Safety of the product has been controlled by compulsory testing of each batch in susceptible chimpanzees. This vaccine (HB vaccine) was used for the prophylaxis of Hepatitis B in hospital staff working in high-risk settings and patients undergoing periodic dialysis since the Autumn of 1975. Tolerance to the HB vaccine was excellent both in staff and patients as assessed by a nation-side survey on a thousand vaccinees. More than 96% of the staff developed protective levels of anti-HBs after three injections of vaccine given at one month intervals and became fully immune from HBV infection. A booster injection given at one year stimulated an anamnestic rise of anti-HBs sufficient to ensure protective levels of antibody for at least five years post-booster. The response of renal patients varied according to the age of recipients: young patients responded equally as well as the healthy staff, while patients over the sixth decade had a lower and delayed response. Because of that, a fourth injection of HB vaccine was advocated in elderly patients. Dialysis patients who developed anti-HBs either after three or four injections were fully protected against chronic HBV infections. Anti-HBs positive donors who had received a single booster injection of HB vaccine and vaccinees who had received their 12 months booster were both found to be an adequate source of high-titre anti-HBs plasma for preparing hyperimmune anti-HBs globulin. The HB vaccine which is manufactured by Institut Pasteur Production under the name HEVAC B degrees is now used world-wide for the prophylaxis of hospital acquired infection in developed countries and for the prevention of maternal-infant transmission in the endemic countries of Asia and Africa.

Adult↗

Assessment of nurses' attitudes and knowledge regarding pain management.

BACKGROUND: RNs in North Carolina were surveyed to determine their current knowledge and to determine if educational preparation, practice setting, or clinical specialty influenced their knowledge levels and attitudes. METHOD: A stratified random sample of 1,000 practicing RNs in North Carolina were surveyed using the Nurses' Knowledge and Attitudes Survey Instrument developed by McCaffery and Ferrell. RESULTS: The mean score was 64.58 based on the percentage of correct responses from the 260 subjects who participated. No statistically significant difference was found in scores based on educational preparation, practice setting, or clinical specialty. CONCLUSION: The findings of this study support the concern of inadequate knowledge and inappropriate attitudes regarding pain management. It reveals the need for intensive continuing education and staff development.

Adult↗